Ababneh Omar, Alghanem Subhi, Al-Shudifat Abdulrahman, Khreesha Lubna, Obeidat Salameh, Bsisu Isam
Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, Jordan.
Division of Neurosurgery, Department of Special Surgery, School of Medicine, The University of Jordan, Amman, Jordan.
Int Med Case Rep J. 2020 Aug 31;13:391-397. doi: 10.2147/IMCRJ.S265206. eCollection 2020.
Macroglossia is a rare life-threatening postoperative complication in patients undergoing neurosurgical operations in a sitting position. It is difficult to identify the cause of macroglossia, which can be considered multifactorial in most patients.
We herein present a case of a 37-year-old female patient who was known to have a posterior occipital lesion (low-grade glioma with pilocytic features) and underwent occipital craniectomy followed by supratentorial approach for debulking of the tumor under general anesthesia in a sitting position. The patient developed upper airway edema along with extreme macroglossia immediately following extubation, with increasing difficulty in ventilation. Re-intubation was impossible, and urgent tracheostomy was performed. In the intensive care unit (ICU), the macroglossia worsened, and the patient developed sepsis with multi-organ failure and died 16 days postoperatively.
Acute macroglossia can be a catastrophic postoperative complication, necessitating early identification and a systematic approach to this critical event, in addition to being fully prepared to deal with difficult airway should this complication occur.
巨舌症是坐位接受神经外科手术患者中一种罕见的危及生命的术后并发症。巨舌症的病因难以确定，在大多数患者中可认为是多因素导致的。
我们在此报告一例37岁女性患者，该患者已知患有枕后病变（具有毛细胞特征的低级别胶质瘤），在全身麻醉下于坐位接受枕下颅骨切除术，随后采用幕上入路进行肿瘤减瘤手术。患者拔管后立即出现上气道水肿并伴有极度巨舌症，通气困难逐渐加重。无法再次插管，遂紧急行气管切开术。在重症监护病房（ICU），巨舌症恶化，患者并发败血症及多器官功能衰竭，术后16天死亡。
急性巨舌症可能是一种灾难性的术后并发症，除了要充分准备应对该并发症可能出现的困难气道情况外，还需要早期识别并对这一关键事件采取系统的处理方法。
